title: SBRT in unresectable advanced pancreatic cancer: preliminary results of a mono-institutional experience.
abstract: BACKGROUND
  To assess the efficacy and safety of stereotactic body radiotherapy (SBRT) in patients with either unresectable locally advanced pancreatic adenocarcinoma or by locally recurrent disease after surgery.
  
  
  METHODS
  Between January 2010 and October 2011, 30 patients with unresectable or recurrent pancreatic adenocarcinoma underwent exclusive SBRT. Twenty-one patients (70%) presented with unresectable locally advanced disease and 9 patients (30%) showed local recurrence after surgery. No patients had metastatic disease. Gemcitabine-based chemotherapy was administered to all patients before SBRT. Prescription dose was 45Gy in 6 daily fractions of 7.5Gy. SBRT was delivered using the volumetric modulated arc therapy (VMAT) by RapidArc. Primary end-point of this study was freedom from local progression (FFLP), secondary end-points were overall survival (OS), progression free survival (PFS) and toxicity.
  
  
  RESULTS
  Median Clinical Target Volume (CTV) was 25.6 cm3 (3.2-78.8 cm3) and median Planning Target Volume (PTV) was 70.9 cm3 (20.4- 205.2 cm3). The prescription dose was delivered in 25 patients (83%), in 5 patients (17%) it was reduced to 36Gy in 6 fractions not to exceed the dose constraints of organs at risk (OARs). Median follow-up was 11 months (2-28 months). FFLP was 91% at 6 months, 85% at median follow-up and 77% at 1 and 2 years. For the group with prescription dose of 45Gy, FFLP was 96% at 1 and 2 years. The median PFS was 8 months. The OS was 47% at 1 year and median OS was 11 months. At the end of the follow-up, 9 patients (32%) were alive and 4 (14%) were free from progression. No patients experienced G ≥ 3 acute toxicity.
  
  
  CONCLUSIONS
  Our preliminary results show that SBRT can obtain a satisfactory local control rate for unresectable locally advanced and recurrent pancreatic adenocarcinoma. This fractionation schedule is feasible, and no G ≥ 3 toxicity was observed. SBRT is an effective emerging technique in the multi-modality treatment of locally advanced pancreatic tumors.
authors.forename: Angelo
authors.initials: A
authors.lastname: Tozzi
authors.forename: Tiziana
authors.initials: T
authors.lastname: Comito
authors.forename: Filippo
authors.initials: F
authors.lastname: Alongi
authors.forename: Pierina
authors.initials: P
authors.lastname: Navarria
authors.forename: Cristina
authors.initials: C
authors.lastname: Iftode
authors.forename: Pietro
authors.initials: P
authors.lastname: Mancosu
authors.forename: Giacomo
authors.initials: G
authors.lastname: Reggiori
authors.forename: Elena
authors.initials: E
authors.lastname: Clerici
authors.forename: Lorenza
authors.initials: L
authors.lastname: Rimassa
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zerbi
authors.forename: Antonella
authors.initials: A
authors.lastname: Fogliata
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzi
authors.forename: Stefano
authors.initials: S
authors.lastname: Tomatis
authors.forename: Marta
authors.initials: M
authors.lastname: Scorsetti
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods*; D000093542:Gemcitabine
chemical_list: D000700:Analgesics; D003841:Deoxycytidine; D000093542:Gemcitabine